101
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[His bundle and left bundle branch pacing]. Herz 2021; 46:499-512. [PMID: 34766195 DOI: 10.1007/s00059-021-05080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
Cardiac pacemakers are an extremely effective treatment for bradycardia but can, however, cause desynchronization of ventricular contraction leading to cardiomyopathy. Pacing of the conduction system can prevent and even reverse desynchronization, which is impressively visible in echocardiography with speckle tracing. His' bundle and left bundle branch pacing requires a specific implantation technique, sheaths and leads which can achieve successful stimulation of the conduction system in up to 98% of cases. Data on conduction system pacing have been acquired in numerous studies but only a few randomized outcome studies. Therefore, in the current European guidelines His' bundle and left bundle branch pacing only have a low level recommendation. The guidelines recommend His' bundle pacing in patients in whom a coronary sinus lead cannot be implanted and in patients with permanent atrial fibrillation and planned atrioventricular (AV) node ablation for heart rate control. Additionally, conduction system pacing appears to be meaningful in patients with an AV block who require pacing of the ventricle for ≥20% of the time or who already show a slightly or moderately reduced left ventricular ejection fraction (36-50%). Even in patients scheduled for generator replacement who have developed a cardiac pacemaker-induced cardiomyopathy, the opportunity should not be missed to upgrade the system by implantation of a His' bundle electrode.
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102
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Wang Z, Zhu H, Li X, Yao Y, Liu Z, Fan X. Left bundle branch area pacing versus right ventricular pacing in patients with persistent atrial fibrillation requiring ventricular pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:2024-2030. [PMID: 34699072 DOI: 10.1111/pace.14394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/09/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aims to assess whether left bundle branch area pacing (LBBAP) can result in favorable clinical and echocardiographic outcomes among patients with persistent atrial fibrillation (PeAF). METHODS We prospectively enrolled consecutive patients with PeAF if they required ventricular pacing and had left ventricular ejection fraction (LVEF) > 35%. During the same period, two experienced operators performed LBBAP and right ventricular pacing (RVP). All-cause death and heart failure hospitalization (HFH) were routinely followed after procedure. The primary outcome was the composite endpoints of all-cause death or HFH. RESULTS LBBAP was successful in 49 of 52 patients (94.2%), whereas 44 patients received RVP. During a mean follow-up of 13.9 ± 7.0 months, LBBAP group presented with higher ventricular pacing percentage (80% vs. 50.9%, p = .04) and narrower paced QRS duration (117.2 ± 18.8 ms vs. 151.8 ± 13.7 ms, p < .001) than RVP group. The primary endpoint was slightly reduced in LBBAP group than RVP without reaching statistical significance (7.7% vs. 11.4%, p = .48). Compared with baseline, we observed significant changes in LVEF (+0.7% vs. -2.2%, p = .007) and left atrial diameter (-1.63 mm vs. +1.23 mm, p = .011) between LBBAP and RVP. CONCLUSION Our results indicate possible effect of LBBAP on reverse remodeling of left atrium and a trend towards favorable clinical outcomes in patients with PeAF requiring high burden of ventricular pacing when compared with RVP.
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Affiliation(s)
- Zhao Wang
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haojie Zhu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofei Li
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Yao
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhimin Liu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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103
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Abstract
Right ventricular (RV) pacing-induced cardiomyopathy (PICM) is typically defined as left ventricular systolic dysfunction resulting from electrical and mechanical dyssynchrony caused by RV pacing. RV PICM is common, occurring in 10-20% of individuals exposed to frequent RV pacing. Multiple risk factors for PICM have been identified, including male sex, wider native and paced QRS durations, and higher RV pacing percentage, but the ability to predict which individuals will develop PICM remains modest. Biventricular and conduction system pacing, which better preserve electrical and mechanical synchrony, typically prevent the development of PICM and reverse left ventricular systolic dysfunction after PICM has occurred.
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Affiliation(s)
- Shaan Khurshid
- Division of Cardiology and Cardiovascular Research Center, Massachusetts General Hospital, Yawkey 5B Heart Center, 55 Fruit Street, Boston, MA 02114, USA
| | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, PA 19104, USA.
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104
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Abstract
Right ventricular pacing for bradycardia remains the mainstay of pacing therapy. Chronic right ventricular pacing may lead to pacing-induced cardiomyopathy. We focus on the anatomy of the conduction system and the clinical feasibility of pacing the His bundle and/or left bundle conduction system. We review the hemodynamics of conduction system pacing, the techniques to capture the conduction system and the electrocardiogram and pacing definitions of conduction system capture. Clinical studies of conduction system pacing in the setting of atrioventricular block and after AV junction ablation are reviewed and the evolving role of conduction system pacing is compared with biventricular pacing.
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105
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Patient Selection for Biventricular Cardiac Resynchronization Therapy, His Bundle Pacing, and Left Bundle Branch Pacing. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00684-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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106
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Qu Q, Sun JY, Zhang ZY, Kan JY, Wu LD, Li F, Wang RX. His-Purkinje conduction system pacing: A systematic review and network meta-analysis in bradycardia and conduction disorders. J Cardiovasc Electrophysiol 2021; 32:3245-3258. [PMID: 34664764 DOI: 10.1111/jce.15269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND His-Purkinje conduction system pacing (HPCSP) has emerged as an effective alternative to overcome the limitations of right ventricular pacing (RVP) via physiological left ventricular activation, but there remains a paucity of comparative information for His bundle pacing (HBP) and left bundle branch pacing (LBBP). METHODS A Bayesian random-effects network analysis was conducted to compare the relative effects of HBP, LBBP, and RVP in patients with bradycardia and conduction disorders. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from database inception until September 21, 2021. RESULTS Twenty-eight studies involving 4160 patients were included in this meta-analysis. LBBP significantly improved success rate, pacing threshold, pacing impedance, and R-wave amplitude compared with HBP. LBBP also demonstrated a nonsignificant trend towards superior outcomes of lead complications, heart failure hospitalization, atrial fibrillation, and all-cause death. However, HBP was associated with significantly shorter paced QRS duration relative to LBBP. Despite higher success rates, shorter procedure/fluoroscopy duration, and fewer lead complications, patients receiving RVP were more likely to experience reduced left ventricular ejection fraction, longer paced QRS duration, and higher rates of heart failure hospitalization than those receiving HPCSP. No statistical differences were observed in the remaining outcome measures. CONCLUSIONS This network meta-analysis demonstrates the efficacy and safety of HPCSP for the treatment of bradycardia and conduction disorders, with differences in pacing parameters, electrophysiology characteristics, and clinical outcomes between HBP and LBBP. Larger-scale, long-term comparative studies are warranted for further verification.
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Affiliation(s)
- Qiang Qu
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Yu Sun
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhen-Ye Zhang
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Jun-Yan Kan
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Li-Da Wu
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Feng Li
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Ru-Xing Wang
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
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107
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Manolis AS, Manolis AA, Manolis TA, Melita H. Electrocardiography of cardiac resynchronization therapy: Pitfalls and practical tips. J Cardiovasc Electrophysiol 2021; 32:3228-3244. [PMID: 34664758 DOI: 10.1111/jce.15267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/11/2021] [Accepted: 09/29/2021] [Indexed: 12/25/2022]
Abstract
Cardiac resynchronization therapy (CRT) has been established as an effective mode of therapy in patients with heart failure and concurrent cardiac dyssynchrony, principally in the form of left bundle branch block (LBBB). The widespread use of CRT has ushered in a new landscape in 12-lead electrocardiography (ECG). ECG readings in these patients are most important to guide troubleshooting and also appropriate device programming, as well as discerning and managing nonresponders. A set of four ECG recordings need to accompany each patient with a CRT device, including a baseline ECG and recordings from monochamber (right and left ventricular) and biventricular pacing, which can be compared against a new recording to facilitate the evaluation of proper versus problematic biventricular pacing. Precordial ECG leads V1/2 acquired at the fourth intercostal space and limb leads, I and III, together with a quick assessment of perpendicular leads I and aVF to determine the quadrant of the QRS axis in the hexaxial diagram, may provide the framework for proper ECG interpretation in these patients. This important issue of 12-lead ECG in CRT patients is herein reviewed, pitfalls are pointed out and practical tips are provided for ECG reading to help recognize and manage problems with CRT device function. Furthermore, several pertinent ECG recordings and tabulated data are provided, and an algorithm is suggested that integrates prior algorithms and relevant information from current literature.
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Affiliation(s)
- Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | | | | | - Helen Melita
- Central Laboratories, Onassis Cardiac Surgery Center, Athens, Greece
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108
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Shimeno K, Tamura S, Nakatsuji K, Hayashi Y, Abe Y, Naruko T. Characteristics and proposed mechanisms of QRS morphology observed during the left bundle branch pacing procedure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1987-1994. [PMID: 34662435 DOI: 10.1111/pace.14382] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In performing left bundle branch pacing (LBBP), various QRS morphologies are observed as the lead penetrates the ventricular septum (VS). This study aimed to evaluate these characteristics and infer the mechanism underlying each QRS morphology. METHODS In 19 patients who met the strict criteria for LBB capture, we classified the QRS morphologies observed during the LBBP procedure into seven patterns, the first five of which were determined by the depth of penetration: right ventricular septal pacing (RVSP), intraventricular septal pacing (IVSP1 and IVSP2), endocardial side of left ventricular septal pacing (LVSeP), nonselective LBBP (NS-LBBP), selective LBBP (S-LBBP), and NS-LBBP with anodal capture. The parameters of the QRS morphologies in these seven patterns were evaluated. RESULTS Among the first five patterns, stimulus-QRSend duration (s-QRSend) was the narrowest in IVSP1 rather than in NS-LBBP, and stimulus-to-peak of R wave in V6 (s-LVAT) was significantly shortened in two steps, from RVSP to IVSP1 (96 ± 11; 82 ± 8 ms, p < .01) and from LVSeP to NS-LBBP (76 ± 7; 60 ± 4 ms, p < .01). The late-R duration in V1 was significantly prolonged in the order of LVSeP, NS-LBBP, and S-LBBP (45 ± 7; 53 ± 10; 71 ± 15 ms, respectively, p < .01). CONCLUSIONS s-QRSend was the narrowest in IVSP1 rather than in NS-LBBP among the QRS morphologies observed during lead penetration through the VS. The prolonged late-R duration in V1 and abrupt shortening of the s-LVAT in V6 may help determine LBB capture during lead penetration.
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Affiliation(s)
- Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Shota Tamura
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | | | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
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109
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Tan JL, Lee JZ, Terrigno V, Saracco B, Saxena S, Krathen J, Hunter K, Cha YM, Russo AM. Outcomes of Left Bundle Branch Area Pacing for Cardiac Resynchronization Therapy: An Updated Systematic Review and Meta-analysis. CJC Open 2021; 3:1282-1293. [PMID: 34888508 PMCID: PMC8636235 DOI: 10.1016/j.cjco.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/30/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Real-world data on the use of left bundle branch area pacing (LBBAP) as an alternative novel pacing strategy to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT) remains scarce. We aimed to investigate the outcomes of LBBAP as an alternative to BVP as a method of CRT. METHODS Electronic databases were searched for studies on the use of LBBAP as CRT and studies that compared LBBAP with BVP. The main outcomes examined were changes in New York Heart Association classification, left ventricular end-diastolic diameter, left ventricular ejection fraction, and paced QRS duration post CRT device implantation. RESULTS Our meta-analysis included 8 nonrandomized studies with a total of 527 patients who underwent LBBAP as CRT. In studies with a BVP comparison group, patients with LBBAP had a greater reduction in paced QRS (mean difference [MD], 27.91 msec; 95% confidence interval [CI], 22.33-33.50), and a greater improvement in New York Heart Association class (MD, 0.59; 95% CI, 0.28-0.90) and left ventricular ejection fraction (MD, 6.77%; 95% CI, 3.84-9.71). Patients with underlying left bundle branch block appeared to benefit the most from LBBAP compared with patients without underlying left bundle branch block. CONCLUSIONS LBBAP might be a reasonable option for patients who meet indications for CRT, particularly in those who have limited anatomy or do not benefit from CRT. Randomized trials are needed to compare LBBAP with BVP for CRT and to identify which populations might benefit the most from LBBAP.
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Affiliation(s)
- Jian Liang Tan
- Division of Cardiovascular Disease, Cooper University Health Care/Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Justin Z Lee
- Department of Cardiovascular Disease, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Vittorio Terrigno
- Department of Internal Medicine, Cooper University Health Care/Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Benjamin Saracco
- Research and Digital Services, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Shivam Saxena
- Division of Cardiovascular Disease, Cooper University Health Care/Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Jonathan Krathen
- Division of Cardiovascular Disease, Cooper University Health Care/Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Disease, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Andrea M. Russo
- Division of Cardiovascular Disease, Cooper University Health Care/Cooper Medical School of Rowan University, Camden, New Jersey, USA
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110
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Cioffi GM, Gasperetti A, Tersalvi G, Schiavone M, Compagnucci P, Sozzi FB, Casella M, Guerra F, Dello Russo A, Forleo GB. Etiology and device therapy in complete atrioventricular block in pediatric and young adult population: Contemporary review and new perspectives. J Cardiovasc Electrophysiol 2021; 32:3082-3094. [PMID: 34570400 DOI: 10.1111/jce.15255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/24/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022]
Abstract
Complete atrioventricular block (CAVB) is a total dissociation between the atrial and ventricular activity, in the absence of atrioventricular conduction. Several diseases may result in CAVB in the pediatric and young-adult population. Permanent right ventricular (RV) pacing is required in permanent CAVB, when the cause is neither transient nor reversible. Continuous RV apical pacing has been associated with unfavorable outcomes in several studies due to the associated ventricular dyssynchrony. This study aims to summarize the current literature regarding CAVB in the pediatric and young adult population and to explore future treatment perspectives.
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Affiliation(s)
- Giacomo M Cioffi
- Division of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Alessio Gasperetti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy.,Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy.,Department of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Gregorio Tersalvi
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Marco Schiavone
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Fabiola B Sozzi
- Department of Cardiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Giovanni Battista Forleo
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
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111
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Retrograde penetration pacing into the conduction system as an alternative approach of his-bundle pacing: Retrograde penetration pacing into the conduction system. J Cardiol 2021; 79:127-133. [PMID: 34518073 DOI: 10.1016/j.jjcc.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/04/2021] [Accepted: 08/14/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The optimal right ventricular (RV) pacing site during pacemaker implantation is still unclear due to left ventricular (LV) dyssynchrony by traditional RV pacing. His-bundle (HIS) pacing has achieved narrow QRS and maintained LV synchrony but high failure rate. RV septal pacing occasionally has QRS waveform with wide and narrow component in the early and late phase, respectively, and maintains LV synchrony, reflecting the normal conduction system. We aimed to define this QRS waveform as retrograde penetration pacing into the conduction system (RPP-CS) and compared its effect on LV synchrony as an alternative approach of HIS pacing. METHODS AND RESULTS We enrolled 42 patients with atrio ventricular block (AVB) or bradycardia atrial fibrillation (AF) requiring pacemaker implantation (RPP-CS, n = 27; no RPP-CS, n = 15). Baseline characteristics were similar between the groups. RPP-CS was observed in 96% and 26% of the RV septum and apex area, respectively. RPP-CS had a significantly shorter QRS width (p < 0.001). The frequency of maintaining LV synchrony was significantly higher in RPP-CS (67% vs. 20%, p = 0.003). The QRS interval's optimal cut-off value during RPP-CS was 132 ms for prediction of LV synchrony (sensitivity 83%, specificity 89%, positive predictive value 94%, and negative predictive value 73%). During RPP-CS, shorter QRS intervals (QRS ≤ 132 ms) had better postoperative LV ejection fraction than longer intervals (p < 0.001). CONCLUSIONS RPP-CS, especially with short QRS intervals (≤132 ms), had a high frequency of LV synchrony, maintained postoperative cardiac function, and may be an adequate first-line RV pacing site strategy for AVB or bradycardia AF as an alternative approach of HIS pacing.
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112
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 893] [Impact Index Per Article: 297.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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113
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Wei HQ, Li H, Liao H, Liang Y, Zhan X, Zhang Q, Deng H, Wei W, Liao Z, Liu Y, Liu F, Lin W, Xue Y, Wu S, Fang X. Feasibility and Safety of Permanent Left Bundle Branch Pacing in Patients With Conduction Disorders Following Prosthetic Cardiac Valves. Front Cardiovasc Med 2021; 8:705124. [PMID: 34490370 PMCID: PMC8418204 DOI: 10.3389/fcvm.2021.705124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022] Open
Abstract
Background: The feasibility and safety of left bundle branch pacing (LBBP) in patients with conduction diseases following prosthetic valves (PVs) have not been well described. Methods: Permanent LBBP was attempted in patients with PVs. Procedural success and intracardiac electrical measurements were recorded at implant. Pacing threshold, complications, and echocardiographic data were assessed at implant and follow-up visit. Results: Twenty-two consecutive patients with atrioventricular (AV) conduction disturbances (10 with AV nodal block and 12 with infranodal block) underwent LBBP. The PVs included aortic valve replacement (AVR) in six patients, mitral valve repair or replacement (MVR) with tricuspid valve ring (TVR) in four patients, AVR with TVR in one patient, AVR with MVR plus TVR in three patients, transcatheter aortic valve replacement (TAVR) in five patients, and MVR alone in three patients. LBBP succeeded in 20 of 22 (90.9%) patients. LBB potential was observed in 15 of 22 (68.2%) patients, including 10 of 15 (66.7%) patients with AVR/TAVR and five of seven (71.4%) patients without AVR/TAVR. AVR and TVR served as good anatomic landmarks for facilitating the LBBP. The final sites of LBBP were 17.9 ± 1.4 mm inferior to the AVR and 23.0 ± 3.2 mm distal and septal to the TVR. The paced QRS duration was 124.5 ± 13.8 ms, while the baseline QRS duration was 120.0 ± 32.5 ms (P = 0.346). Pacing threshold and R-wave amplitude at implant were 0.60 ± 0.16 V at 0.5 ms and 11.9 ± 5.5 mV and remained stable at the mean follow-up of 16.1 ± 10.8 months. No significant exacerbation of tricuspid valve regurgitation was observed compared to baseline. Conclusion: Permanent LBBP could be feasibly and safely obtained in the majority of patients with PVs. The location of the PV might serve as a landmark for guiding the final site of the LBBP. Stable pacing parameters were observed during the follow-up.
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Affiliation(s)
- Hui-Qiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongtao Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanhong Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xianzhang Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qianhuan Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zili Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yang Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fangzhou Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weidong Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xianhong Fang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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114
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Ponnusamy SS, Vijayaraman P. How to Implant His Bundle and Left Bundle Pacing Leads: Tips and Pearls. Card Fail Rev 2021; 7:e13. [PMID: 34466272 PMCID: PMC8383140 DOI: 10.15420/cfr.2021.04] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/04/2021] [Indexed: 01/23/2023] Open
Abstract
Cardiac pacing is the treatment of choice for the management of patients with bradycardia. Although right ventricular apical pacing is the standard therapy, it is associated with an increased risk of pacing-induced cardiomyopathy and heart failure. Physiological pacing using His bundle pacing and left bundle branch pacing has recently evolved as the preferred alternative pacing option. Both His bundle pacing and left bundle branch pacing have also demonstrated significant efficacy in correcting left bundle branch block and achieving cardiac resynchronisation therapy. In this article, the authors review the implantation tools and techniques to perform conduction system pacing.
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Hasumi E, Fujiu K. Tripartite Left Bundle Branch Area Pacing. Int Heart J 2021; 62:1-3. [PMID: 33518650 DOI: 10.1536/ihj.20-771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Eriko Hasumi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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Zweerink A, Bakelants E, Stettler C, Burri H. Cryoablation vs. radiofrequency ablation of the atrioventricular node in patients with His-bundle pacing. Europace 2021; 23:421-430. [PMID: 33241283 DOI: 10.1093/europace/euaa344] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Radiofrequency ablation (RFA) of the atrioventricular node (AVN) with His-bundle pacing (HBP) can cause rise in capture thresholds. Cryoablation (CRYO) may offer reversibility in case of threshold rise but has never been tested for AVN ablation in this setting. Our aim was to compare procedural characteristics and outcome of CRYO compared with RFA for AVN ablation in patients with HBP. METHODS AND RESULTS Forty-four patients with HBP underwent AVN ablation for an 'ablate and pace' indication. Cryoablation was performed in the first 22 patients and RFA in the following 22 patients. Procedural characteristics, success rates, and change in His capture thresholds were compared between groups. Distance from the ablation site to the His lead was measured using biplane fluoroscopy. Acute success was 100% with both strategies. Median procedural duration was significantly longer for CRYO {50 [interquartile range (IQR) 38-63] min} compared with RFA [36 (IQR, 30-41) min; P = 0.027]. An acute threshold rise of ≥1 V was observed in four CRYO (one complete loss of capture) and three RFA patients (P = 0.38), with all of the applications being within 6 mm of the His lead tip. During follow-up, nine patients had AVN re-conduction (six CRYO vs. three RFA; P = 0.58), but only four patients required a redo procedure (all CRYO; P = 0.09). CONCLUSION Cryoablation does not offer any advantage over RFA for AVN ablation in patients with HBP and tended to require more redo procedures. If possible, a distance of ≥6 mm should be maintained from the His lead tip to avoid a rise in capture thresholds.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
| | - Elise Bakelants
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
| | - Carine Stettler
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
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Beer D, Subzposh FA, Colburn S, Naperkowski A, Vijayaraman P. His bundle pacing capture threshold stability during long-term follow-up and correlation with lead slack. Europace 2021; 23:757-766. [PMID: 33236070 DOI: 10.1093/europace/euaa350] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS His bundle pacing (HBP) is the most physiologic form of pacing. Long-term HBP capture threshold stability and its relation to lead characteristics at the time of implantation have not been adequately described. The aim of this study was to characterize HB capture threshold in follow-up and to identify potential lead characteristics predictive of lead capture instability. METHODS AND RESULTS Consecutive patients with successful HBP for bradycardia indications were identified from the Geisinger HBP registry. His bundle capture thresholds, baseline comorbidities, and radiographic lead slack characteristics were analysed. An increase in HB capture threshold ≥1 V above implant values at any time during follow-up was tracked. Forty-four of the 294 studied (15%) experienced HB capture threshold increase by ≥ 1 V. Threshold increase was seen early (41% by 8 weeks, 66% by 1 year). Eighteen (6%) patients required lead revision in follow-up. Abnormal slack shape was associated with a trend toward capture threshold increase [hazard ratio (HR) 2.07; 95% confidence interval (CI) 0.9-4.6; P = 0.08]. Non-perpendicular angle of lead insertion on radiography was associated with the capture threshold increase (HR 2.81, 95% CI 1.4-5.8; P < 0.01). CONCLUSION His bundle capture threshold remains stable in the majority (85%) of patients. Implant characteristics may predict the threshold rise. Further evaluation of the aetiology of threshold increase and design changes in lead and delivery systems may lead to chronically stable capture thresholds.
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Affiliation(s)
- Dominik Beer
- Geisinger Commonwealth School of Medicine Director, Cardiac Electrophysiology Geisinger Heart Institute MC 36-10, 1000 E Mountain Blvd Wilkes-Barre, PA 18711, USA
| | - Faiz A Subzposh
- Geisinger Commonwealth School of Medicine Director, Cardiac Electrophysiology Geisinger Heart Institute MC 36-10, 1000 E Mountain Blvd Wilkes-Barre, PA 18711, USA
| | - Shaun Colburn
- Geisinger Commonwealth School of Medicine Director, Cardiac Electrophysiology Geisinger Heart Institute MC 36-10, 1000 E Mountain Blvd Wilkes-Barre, PA 18711, USA
| | - Angela Naperkowski
- Geisinger Commonwealth School of Medicine Director, Cardiac Electrophysiology Geisinger Heart Institute MC 36-10, 1000 E Mountain Blvd Wilkes-Barre, PA 18711, USA
| | - Pugazhendhi Vijayaraman
- Geisinger Commonwealth School of Medicine Director, Cardiac Electrophysiology Geisinger Heart Institute MC 36-10, 1000 E Mountain Blvd Wilkes-Barre, PA 18711, USA
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Sheng X, Pan YW, Yu C, Wang B, Zhang P, Li J, Zhang JF, Chen SQ, Wang M, Sun YX, Jiang DM, Yang Y, Ye Y, Cha YM, Fu GS. Comparison of synchronization between left bundle branch and his bundle pacing in atrial fibrillation patients: An intra-patient-controlled study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1523-1531. [PMID: 34337768 PMCID: PMC9291595 DOI: 10.1111/pace.14331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
Background His bundle pacing (HBP) is a physiological pacing strategy to preserve the electrical synchrony of ventricular conduction and left ventricular (LV) function. Left bundle branch pacing (LBBP) has emerged as an alternative physiological pacing technique. Objective To evaluate cardiac electrical and mechanical synchrony comparing LBBP and HBP in patients with permanent atrial fibrillation (AF). Methods Consecutive patients with symptomatic bradycardia and AF were enrolled from January to June of 2019. The cardiac electrical and mechanical synchrony in different pacing mode were evaluated at baseline and after implantation. Results Both HBP and LBBP were performed in 20 patients. LBBP significantly widened the QRS duration compared with the intrinsic conduction (113.2 ± 14.5 vs. 96.5 ± 16.2 ms; p = .01), while HBP did not (104.5 ± 22.3 vs. 96.5 ± 16.2 ms; p = .12). Both LBBP and HBP patients had similar LV myocardial strain measurements for the mechanical synchrony evaluation without significant change compared with baseline. There was no significant difference in right ventricular synchrony measurement between LBBP and HBP. Compared to HBP, LBBP had less interventricular synchrony (IMVD, 14.7 ± 9.2 vs. 3.1 ± 12.7 ms, p < .01; Ts‐LV‐RV, 37.9 ± 10.7 vs. 18.5 ± 10.8 ms, p < .001). Conclusions Although LBBP's a physiological pacing mode can achieve a similar cardiac electrical and mechanical synchronization when compared to HBP, LBBP results in modest delay in RV activation, and the clinical implication remains to be studied.
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Affiliation(s)
- Xia Sheng
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Yi-Wen Pan
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Chan Yu
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Bei Wang
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Pei Zhang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Jing Li
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China.,Department of Cardiology, Jinhua Wenrong Hospital, Jinhua, 322118, China
| | - Jie-Fang Zhang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Shi-Quan Chen
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Min Wang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Ya-Xun Sun
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Dong-Mei Jiang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Ying Yang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Yang Ye
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Guo-Sheng Fu
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
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Bhaskaran A, Liang T, Niri A, Azam MA, Massé S, Asta J, Magtibay K, Lai PFH, Labos C, Ha ACT, Nanthakumar K. Multi-Axis Lead with Tetrahedral Electrode Tip for Cardiac Implantable Devices: Creative Concept for Pacing and Sensing Technology. Can J Cardiol 2021; 37:1808-1817. [PMID: 34333028 DOI: 10.1016/j.cjca.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We developed a multi-axis lead (MaxLead) incorporating four electrodes arranged at the lead-tip organized in an equidistant tetrahedron. Here, we studied MaxLead performance in sensing, pacing and activation wavefront-direction analysis. METHODS Sixteen explanted animal hearts (from 7 pigs, 7 sheep and 2 rabbits) were used. Pacing threshold was tested from all axes of MaxLead from RV apex before and after simulated dislodgement. Additionally, conduction-system pacing was performed in sheep heart preparations from all axes of MaxLead. Sensing via MaxLead positioned at RV apex was tested during sinus rhythm (SR), pacing from RV and LV free-wall, and ventricular fibrillation (VF). MaxLead-enabled voltage (MaxV), defined as the largest span of the sensed electric field loop, was compared to traditional lead-tip voltage detection. RESULTS Pacing: MaxLead minimized change in pacing threshold due to lead-dislodgement (average voltage change 0.2 mV, 95% CI (-0.5, 0.9)), using multiple bipoles available for pacing. In animals with high conduction system pacing thresholds (>2mV) in one or more bipoles (3/7), acceptable thresholds (<1 mV) were demonstrated in an average of 2.5 remaining bipoles. Sensing: MaxV of SR and VF was consistently higher than the highest bipolar voltage (voltage difference averaged -0.18 mV, 95% confidence interval (CI: -0.28 to -0.07), p=0.001). Electric field loop geometry consistently differentiated ventricular activation in SR from that during pacing from RV and LV free walls. CONCLUSIONS The multi-axis MaxLead electrode showed advantages in pacing, sensing and mapping and has the potential to allow for improvements in lead/electrode technology for cardiac implanted electronic devices.
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Affiliation(s)
- Abhishek Bhaskaran
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timothy Liang
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ahmed Niri
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Mohammed Ali Azam
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - John Asta
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Karl Magtibay
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Patrick F H Lai
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Andrew C T Ha
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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Vijayaraman P, Patel N, Colburn S, Beer D, Naperkowski A, Subzposh FA. His-Purkinje Conduction System Pacing in Atrioventricular Block: New Insights into Site of Conduction Block. JACC Clin Electrophysiol 2021; 8:73-85. [PMID: 34393084 DOI: 10.1016/j.jacep.2021.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aims to assess the safety and feasibility of achieving His-Purkinje conduction system pacing (HPCSP) in consecutive patients with atrioventricular block (AVB) and to describe the site of conduction block in patients with infranodal AVB. BACKGROUND HPCSP has evolved as the preferred form of physiologic pacing. Left bundle branch area pacing (LBBAP) has emerged as an effective alternative to His bundle pacing (HBP). METHODS Consecutive patients with AVB referred for pacemaker implantation were included in the study. HBP or LBBAP was attempted in all patients. Site of conduction block was identified as nodal or infranodal (intra-Hisian or infra-Hisian) AVB. RESULTS HPCSP was attempted in 333 consecutive patients with AVB and was successful in 322 (97%) patients. HBP was achieved in 140 patients, LBBAP in 179 patients, and both in 3 patients. Site of conduction block was nodal in 55% and infranodal in 45% (intra-Hisian 89%; infra-Hisian 4%; indeterminate 7%). QRS duration at baseline was 111±27 versus 129±31 (P < 0.001) compared to 126 ± 24 vs 125 ± 21 milliseconds (P = 0.75) during HBP and LBBAP, respectively. HBP thresholds at implant were higher compared to LBBAP (1.2 ± 0.7 V at 0.9 milliseconds vs 0.6 ± 0.3 V at 0.5 milliseconds; P < 0.001) but remained stable during follow-up. Lead revision was required in 3% and 2% of patients with HBP and LBBAP, respectively. CONCLUSIONS HPCSP pacing was successfully performed in 97% of unselected patients with AVB irrespective of the site of conduction block. True infra-Hisian block (distal His-Purkinje conduction disease) is rare. HBP and LBBAP were complementary in achieving stable and low capture thresholds.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA.
| | - Neil Patel
- The Wright Center, Scranton, Pennsylvania, USA
| | - Shaun Colburn
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA
| | - Dominik Beer
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Angela Naperkowski
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA
| | - Faiz A Subzposh
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA
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Dideriksen JR, Christiansen MK, Johansen JB, Nielsen JC, Bundgaard H, Jensen HK. Long-term outcomes in young patients with atrioventricular block of unknown aetiology. Eur Heart J 2021; 42:2060-2068. [PMID: 33599276 PMCID: PMC8169155 DOI: 10.1093/eurheartj/ehab060] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/17/2020] [Accepted: 01/31/2021] [Indexed: 12/20/2022] Open
Abstract
Aims Atrioventricular block (AVB) of unknown aetiology is rare in the young, and outcome in these patients is unknown. We aimed to assess long-term morbidity and mortality in young patients with AVB of unknown aetiology. Methods and results We identified all Danish patients younger than 50 years receiving a first pacemaker due to AVB between January 1996 and December 2015. By reviewing medical records, we included patients with AVB of unknown aetiology. A matched control cohort was established. Follow-up was performed using national registries. The primary outcome was a composite endpoint consisting of death, heart failure hospitalization, ventricular tachyarrhythmia, and cardiac arrest with successful resuscitation. We included 517 patients, and 5170 controls. Median age at first pacemaker implantation was 41.3 years [interquartile range (IQR) 32.7–46.2 years]. After a median follow-up of 9.8 years (IQR 5.7–14.5 years), the primary endpoint had occurred in 14.9% of patients and 3.2% of controls [hazard ratio (HR) 3.8; 95% confidence interval (CI) 2.9–5.1; P < 0.001]. Patients with persistent AVB at time of diagnosis had a higher risk of the primary endpoint (HR 10.6; 95% CI 5.7–20.0; P < 0.001), and risk was highest early in the follow-up period (HR 6.8; 95% CI 4.6–10.0; P < 0.001, during 0–5 years of follow-up). Conclusion Atrioventricular block of unknown aetiology presenting before the age of 50 years and treated with pacemaker implantation was associated with a three- to four-fold higher rate of the composite endpoint of death or hospitalization for heart failure, ventricular tachyarrhythmia, or cardiac arrest with successful resuscitation. Patients with persistent AVB were at higher risk. These findings warrant improved follow-up strategies for young patients with AVB of unknown aetiology.
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Affiliation(s)
- Johnni Resdal Dideriksen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Morten K Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, 5000 Odense C, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Henning Bundgaard
- Department of Cardiology B2142, Unit for Inherited Cardiovascular Diseases, The Heart Centre, National University Hospital, 2100 Copenhagen, Denmark
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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The electrocardiogram characteristics and pacing parameters of permanent left bundle branch pacing: a systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 63:215-224. [PMID: 34173915 DOI: 10.1007/s10840-021-01000-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Recent advances in conduction system pacing have led to the use of left bundle branch pacing (LBBP), which has potential advantages over His bundle pacing (HBP). For example, LBBP engages the electrical activation through the left bundle branch, produces ventricular electrical synchrony, and avoids the weakness of HBP such as lead instability, higher threshold, and early battery depletion. This pacing modality has been considered an attractive mode to achieve normal physiological pacing. However, as a new technology, LBBP is still in the stage of clinical exploration and lacks adequate evaluation. This study aims to investigate the electrocardiogram characteristics, pacing parameters, the safety, and the effectiveness of LBBP. METHODS A computerized search of PubMed, Embase, and The Cochrane Library for the effects of LBBP was done. The baseline characteristics of patients, successful rate of implantation, capture threshold, R-wave amplitude, pacing impedance, QRS duration, and follow-up date were extracted and summarized. RESULTS Thirteen studies including 712 patients were included in this analysis. The overall successful rate for implantation was 92.9%. The main indications for LBBP were atrioventricular block (AVB), sinus node dysfunction (SND), atrial fibrillation (AF) with slow ventricular rate, and cardiac resynchronization therapy (CRT) candidates. For patients with QRS duration>120 ms, permanent LBBP resulted in narrower QRS duration compared to that before implantation (P = 0.05). QRS duration and capture threshold of LBBP remained stable during follow-up. Moreover, there was higher R-wave amplitude and lower pacing impedance at follow-up compared to those at implantation (P = 0.01 and P < 0.00001, respectively). CONCLUSIONS Permanent LBBP has shown promising results for pacemaker-indicated patients in small observational studies. Good electrical synchronization, high success rates, and stable pacemaker lead parameters suggested significant advantages of LBBP in physiological pacing. Randomized controlled trials are needed to assess the efficacy of LBBP in patients.
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Chen X, Jin Q, Bai J, Wang W, Qin S, Wang J, Liang Y, Su Y, Ge J. The feasibility and safety of left bundle branch pacing vs. right ventricular pacing after mid-long-term follow-up: a single-centre experience. Europace 2021; 22:ii36-ii44. [PMID: 33370799 DOI: 10.1093/europace/euaa294] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS The aim of this study is to prospectively assess the feasibility and safety of left bundle branch pacing (LBBP) when compared with right ventricular pacing (RVP) during mid-long-term follow-up in a large cohort. METHODS AND RESULTS Patients (n = 554) indicated for pacemaker implantation were prospectively and consecutively enrolled and were non-randomized divided into LBBP group and RVP group. The levels of cTnT and N-terminal pro-B type natriuretic peptide were measured and compared within 2 days post-procedure between two groups. Implant characteristics, procedure-related complications, and clinical outcomes were also compared. Pacing thresholds, sensing, and impedance were assessed during procedure and follow-up. Left bundle branch pacing was feasible with a success rate of 94.8% with high incidence of LBB potential (89.9%), selective LBBP (57.8%), and left deviation of paced QRS axis (79.7%) with mean Sti-LVAT of 65.07 ± 8.58 ms. Paced QRS duration was significantly narrower in LBBP when compared with RVP (132.02 ± 7.93 vs. 177.68 ± 15.58 ms, P < 0.0001) and the pacing parameters remained stable in two groups during 18 months follow-up. cTnT elevation was more significant in LBBP when compared with RVP within 2 days post-procedure (baseline: 0.03 ± 0.03 vs. 0.02 ± 0.03 ng/mL, P = 0.002; 1 day post-procedure: 0.13 ± 0.09 vs. 0.04 ± 0.03 ng/mL, P < 0.001; 2 days post-procedure: 0.10 ± 0.08 vs. 0.03 ± 0.08 ng/mL, P < 0.001). The complications and cardiac outcomes were not significantly different between two groups. CONCLUSION Left bundle branch pacing was feasible in bradycardia patients associated with stable pacing parameters during 18 months follow-up. Paced QRS duration was significantly narrower than that of RVP. Though cTnT elevation was more significant in LBBP within 2 days post-procedure, the complications, and cardiac outcomes were not significantly different between two groups.
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Affiliation(s)
- Xueying Chen
- Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Qinchun Jin
- Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Jin Bai
- Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Wei Wang
- Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Shengmei Qin
- Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Jingfeng Wang
- Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Yixiu Liang
- Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
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Qian Z, Qiu Y, Wang Y, Jiang Z, Wu H, Hou X, Zou J. Lead performance and clinical outcomes of patients with permanent His-Purkinje system pacing: a single-centre experience. Europace 2021; 22:ii45-ii53. [PMID: 33370802 DOI: 10.1093/europace/euaa295] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/03/2020] [Indexed: 01/30/2023] Open
Abstract
AIMS His-Purkinje system (HPS) pacing, including His bundle (HB) and left bundle branch (LBB) pacing, has emerged as a highlighted topic in recent years. Comparisons in lead performance and clinical outcomes between HB and LBB pacing were seldom reported. We aimed to investigate the mid-long-term lead performance and clinical outcomes of permanent HPS pacing patients in our centre. METHODS AND RESULTS Permanent HB pacing was implemented by placing the pacing lead helix at the HB area. Left bundle branch pacing was achieved by placing the lead helix in the left-side sub-endocardium of the interventricular septum. Pacing parameters, 12-lead ECG, echocardiography, and clinical outcomes were evaluated during follow-up. A total of 64 patients with HB pacing and 185 with LBB pacing were included. Left bundle branch pacing exhibited a slightly longer paced QRS duration than HB pacing (117.7 ± 11.0 vs. 113.7 ± 19.8 ms, P = 0.04). Immediate post-operation, LBB pacing had a significant higher R-wave amplitude (16.5 ± 7.5 vs. 4.3 ± 3.6 mV, P < 0.001) and lower capture threshold (0.5 ± 0.1 vs. 1.2 ± 0.8 V, P < 0.001) compared with HB pacing. During follow-up, an increase in capture threshold of >1.0 V from baseline was found in eight (12.5%) patients in the HB pacing group and none in LBB pacing. Paced QRS morphology changed from Qr to QS in lead V1 in seven patients (3.8%) with LBB pacing. Both HB and LBB pacing preserved cardiac function in patients with left ventricular ejection fraction (LVEF) over 50%. In patients with LVEF <50%, both HB and LBB pacing improved clinical outcomes during follow-up. CONCLUSION His-Purkinje system pacing produced favourable electrical synchrony and improved cardiac function in patients with heart failure. Left bundle branch pacing showed superior pacing parameters over HB pacing. Lead micro-displacement with changes in paced QRS morphology posts a concern in LBB pacing.
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Affiliation(s)
- Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Yuanhao Qiu
- Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Zeyu Jiang
- Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Hongping Wu
- Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
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Tokavanich N, Prasitlumkum N, Mongkonsritragoon W, Cheungpasitporn W, Thongprayoon C, Vallabhajosyula S, Chokesuwattanaskul R. A network meta-analysis and systematic review of change in QRS duration after left bundle branch pacing, His bundle pacing, biventricular pacing, or right ventricular pacing in patients requiring permanent pacemaker. Sci Rep 2021; 11:12200. [PMID: 34108548 PMCID: PMC8190182 DOI: 10.1038/s41598-021-91610-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/28/2021] [Indexed: 12/20/2022] Open
Abstract
Cardiac dyssynchrony is the proposed mechanism for pacemaker-induced cardiomyopathy, which can be prevented by biventricular pacing. Left bundle branch pacing and His bundle pacing are novel interventions that imitate the natural conduction of the heart with, theoretically, less interventricular dyssynchrony. One of the surrogate markers of interventricular synchrony is QRS duration. Our study aimed to compare the change of QRS duration before and after implantation between types of cardiac implantable electronic devices (CIEDs): left bundle branch pacing versus His bundle pacing versus biventricular pacing and conventional right ventricular pacing. A literature search for studies that reported an interval change of QRS duration after CIED implantation was conducted utilizing the MEDLINE, EMBASE, and Cochrane databases. All relevant works from database inception through November 2020 were included in this analysis. A random-effects model, Bayesian network meta-analysis was used to analyze QRS duration changes (eg, electrical cardiac synchronization) across different CIED implantations. The mean study sample size, from 14 included studies, was 185 subjects. The search found 707 articles. After exclusions, 14 articles remained with 2,054 patients. The His bundle pacing intervention resulted in the most dramatic decline in QRS duration (mean difference, - 53 ms; 95% CI - 67, - 39), followed by left bundle branch pacing (mean difference, - 46 ms; 95% CI - 60, - 33), and biventricular pacing (mean difference, - 19 ms; 95% CI - 37, - 1.8), when compared to conventional right ventricle apical pacing. When compared between LBBP and HBP, showed no statistically significant wider QRS duration in LBBP with mean different 6.5 ms. (95% CI - 6.7, 21). Our network meta-analysis found that physiologic pacing has the greatest effect on QRS duration after implantation. Thus, HBP and LBBP showed no significant difference between QRS duration after implantation. Physiologic pacing interventions result in improved electrocardiography markers of cardiac synchrony, narrower QRS duration, and might lower electromechanical dyssynchrony.
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Affiliation(s)
- Nithi Tokavanich
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, CA, USA
| | - Wimwipa Mongkonsritragoon
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | | | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
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Ma PP, Yang YH, Dai BL, Zhang RF, Wang N, Li DN, Yin XM, Gao LJ, Xia YL, Yang YZ, Dong YX. Brady-arrhythmias in patients with atrial fibrillation and heart failure of reduced ejection fraction: is his-bundle pacing superior to biventricular pacing?. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1193-1199. [PMID: 34080696 DOI: 10.1111/pace.14289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 04/19/2021] [Accepted: 05/30/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of His-bundle pacing (HBP) compared with the traditional biventricular pacing (BVP) on patients with brady-arrhythmias, who suffer from permanent atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF). METHODS All patients with brady-arrhythmias, permanent AF and HFrEF were continuously enrolled from January 2017 to July 2019 and followed up for at least 12 months. The differences in QRS duration (QRSd), New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), tricuspid regurgitation grade, mitral regurgitation grade, left ventricular end-diastolic diameter (LVEDD), and left atrial size were compared. RESULTS A total of 52 patients were enrolled: 37 patients were with HBP and 15 patients with BVP. There was no electrode dislodged, perforation, infection or thrombosis during the follow-up of 18.12 ± 4.45 months. The success rate for HBP implantation was 88.10%. The capture threshold of his-bundle and the threshold of the left ventricular lead remained stable during follow-up. LVEF increased to higher than 50% in 11 patients with HBP (29.73%). The NYHA classification (both p < .001), LVEF (both p < .001) and LVEDD improved significantly during the follow-up in both groups. NYHA (p = .030), LVEF (p = .013), and LVEDD (p = .003) improved in patients with HBP compared with BVP. CONCLUSION HBP was safe and more effective in improving the cardiac function and remodeling in patients with brady-arrhythmias, permanent AF and HFrEF compared with BVP.
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Affiliation(s)
- Pei-Pei Ma
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yi-Heng Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Bai-Ling Dai
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Rong-Feng Zhang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Nan Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Dan-Na Li
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xiao-Meng Yin
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Lian-Jun Gao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yun-Long Xia
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yan-Zong Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ying-Xue Dong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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127
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Peng X, Chen Y, Wang X, Hu A, Li X. Safety and efficacy of His-bundle pacing/left bundle branch area pacing versus right ventricular pacing: a systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 62:445-459. [PMID: 34019186 DOI: 10.1007/s10840-021-00998-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies have demonstrated that right ventricular pacing (RVP) has deleterious effects on non-synchronized ventricular contraction, while His-bundle pacing (HBP) or left bundle branch area pacing (LBBaP) contribute to improvements in patients' mid- and long-term outcomes. This meta-analysis aimed to compare the safety and efficacy of physiologic pacing (HBP/LBBaP) versus those of RVP. METHODS A systematic search of PubMed, Cochrane Library, and Embase was conducted for studies that compared the effects of physiologic pacing and RVP. All eligible studies were published before January 1, 2021 and were conducted in humans. STATA software version 15.0 was used for all the data analyses. RESULTS Twenty articles (n = 2787 patients) were included in this meta-analysis. Compared to RVP, physiologic pacing was associated with a significantly shorter QRS duration and better cardiac function. Physiologic pacing was also correlated with lower rates of mitral regurgitation, pacing-induced cardiomyopathy, death, heart failure hospitalization, and atrial fibrillation, although the above results were not statistically significant. In addition, RVP led to the achievement of higher success rates than physiologic pacing, a shorter fluoroscopic time and mean procedure duration, a lower pacing threshold: the results were statistically significant. Compared with HBP, LBBaP appeared to have some advantages in R wave amplitudes, pacing threshold, fluoroscopic time, procedure time, and success rate, with statistically significant differences. Whereas HBP was associated with fewer surgical complications and shorter QRS duration, the results were not statistically significant. CONCLUSION Physiologic pacing (HBP/LBBaP) might be a better strategy than RVP and improve long-term clinical outcomes like cardiac function. Although LBBaP appears to have some advantages over HBP, the long-term benefits are still controversial. More large-scale randomized clinical trials are needed for further verification.
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Affiliation(s)
- Xinyi Peng
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yu Chen
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaofei Wang
- Department of Cardiology, Qindao University Medical College Affiliated Yantaiyuhuangding Hospital, Yantai, China
| | - Aizhen Hu
- Department of Cardiology, Qindao University Medical College Affiliated Yantaiyuhuangding Hospital, Yantai, China
| | - Xuexun Li
- Department of Cardiology, Shandong Provincial Hospital, Shandong, 250021, Jinan, China.
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128
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Abstract
Conduction system pacing (CSP) is a technique of pacing that involves implantation of permanent pacing leads along different sites of the cardiac conduction system and includes His bundle pacing and left bundle branch pacing. There is an emerging role for CSP to achieve cardiac resynchronisation in patients with heart failure with reduced ejection fraction and inter-ventricular dyssynchrony. In this article, the authors review these strategies for resynchronisation and the available data on the use of CSP in overcoming dyssynchrony.
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129
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Grieco D, Bressi E, Curila K, Padala SK, Sedlacek K, Kron J, Fedele E, Ionita O, Giannuzzi S, Fagagnini A, Panattoni G, De Ruvo E, Ellenbogen KA, Calò L. Impact of His bundle pacing on right ventricular performance in patients undergoing permanent pacemaker implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:986-994. [PMID: 33890685 DOI: 10.1111/pace.14249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/11/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND His-Bundle pacing (HBP) is an emerging technique for physiological pacing. However, its effects on right ventricle (RV) performance are still unknown. METHODS We enrolled consecutive patients with an indication for pacemaker (PM) implantation to compare HBP versus RV pacing (RVP) effects on RV performance. Patients were evaluated before implantation and after 6 months by a transthoracic echocardiogram. RESULTS A total of 84 patients (age 75.1±7.9 years, 64% male) were enrolled, 42 patients (50%) underwent successful HBP, and 42 patients (50%) apical RVP. At follow up, we found a significant improvement in RV-FAC (Fractional Area Change)% [baseline: HBP 34 IQR (31-37) vs. RVP 33 IQR (29.7-37.2),p = .602; 6-months: HBP 37 IQR (33-39) vs. RVP 30 IQR (27.7-35), p < .0001] and RV-GLS (Global Longitudinal Strain)% [baseline: HBP -18 IQR (-20.2 to -15) vs. RVP -16 IQR (-18.7 to -14), p = .150; 6-months: HBP -20 IQR(-23 to -17) vs. RVP -13.5 IQR (-16 to -11), p < .0001] with HBP whereas RVP was associated with a significant decline in both parameters. RVP was also associated with a significant worsening of tricuspid annular plane systolic excursion (TAPSE) (p < .0001) and S wave velocity (p < .0001) at follow up. Conversely from RVP, HBP significantly improved pulmonary artery systolic pressure (PASP) [baseline: HBP 38 IQR (32-42) mmHg vs. RVP 34 IQR (31.5-37) mmHg,p = .060; 6-months: HBP 32 IQR (26-38) mmHg vs. RVP 39 IQR (36-41) mmHg, p < .0001] and tricuspid regurgitation (p = .005) irrespectively from lead position above or below the tricuspid valve. CONCLUSIONS In patients undergoing PM implantation, HBP ensues a beneficial and protective impact on RV performance compared with RVP.
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Affiliation(s)
- Domenico Grieco
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | - Edoardo Bressi
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy.,Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Karol Curila
- Department of Cardiology, Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Santosh K Padala
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kamil Sedlacek
- 1st Department of Internal Medicine - Cardiology and Angiology, University Hospital and Charles University Medical Faculty, Hradec Kralove, Czech Republic
| | - Jordana Kron
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Elisa Fedele
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | - Oana Ionita
- Department of Cardiology, Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Sara Giannuzzi
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | | | - Germana Panattoni
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | | | - Kenneth A Ellenbogen
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
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130
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Yang YH, Wang KX, Ma PP, Zhang RF, Waleed KB, Yin X, Gao LJ, Xia YL, Dong YX. His-purkinje system pacing upgrade improve the heart performances in patients suffering from pacing-induced cardiomyopathy with or without permanent atrial fibrillation. Int J Cardiol 2021; 335:47-51. [PMID: 33845081 DOI: 10.1016/j.ijcard.2021.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The efficacy and safety of his-purkinje system pacing (HPSP) upgrades in patients with pacing-induced cardiomyopathy (PICM) and atrial fibrillation (AF) are still unknown. METHODS AND RESULTS Patients with PICM were continuously enrolled from January 2018 to March 2020. All patients were further divided into AF subgroup and sinus rhythm subgroup. Clinical data including echocardiographic examination parameters, electrocardiogram (ECG) measurements, and New York Heart Association (NYHA) classification, were assessed before and after the procedure. The HPSP upgrades, including his bundle pacing (HBP) and left bundle branch pacing (LBBP) were completed in 34 of 36 (94%) patients, Complications including electrode dislodged, perforation, infection or thrombosis were not observed in the perioperative period. During a mean of 11.52 ± 5.40 months of follow-up. The left ventricular ejection fraction (LVEF) increased significantly (33.76 ± 7.54 vs 40.41 ± 9.06, P < 0.001), and the QRS duration decreased (184.22 ± 23.76 ms vs 120.52 ± 16.67 ms, P < 0.001) after the upgrades. LVEDD reversed from 59.29 ± 7.74 mm to 53.91 ± 5.92 mm (P < 0.001), and the NYHA functional class also improved to 2.00 ± 0.76 from 2.55 ± 0.91 at the first follow-up (P < 0.001). The left atrium (LA) size also slightly decreased compared to the initial state (47.44 ± 7.14 mm VS 45.56 ± 7.78, P = 0.010). BNP significantly decreased from a median value of 458.06(256.35-755.10) to 172.31(92.69-552.14) (P = 0.004). The threshold did not increase significantly (1.18 ± 0.76 mv@0.4 ms vs 1.26 ± 0.91mv @ 0.4 ms, P = 0.581). These improvements in patients with AF were similar with those in patients without AF (P > 0.05). CONCLUSIONS HPSP upgrades improved the heart performance and reversed the left ventricular remodeling in patients suffering from PICM with or without AF, and it should be a promising choice in these patients.
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Affiliation(s)
- Yi-Heng Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ke-Xin Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Pei-Pei Ma
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Rong-Feng Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Khalid Bin Waleed
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China; Department of cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, Guangdong, China
| | - Xiaomeng Yin
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lian-Jun Gao
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yun-Long Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Ying-Xue Dong
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
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131
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Liu P, Wang Q, Sun H, Qin X, Zheng Q. Left Bundle Branch Pacing: Current Knowledge and Future Prospects. Front Cardiovasc Med 2021; 8:630399. [PMID: 33834042 PMCID: PMC8021709 DOI: 10.3389/fcvm.2021.630399] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/05/2021] [Indexed: 12/16/2022] Open
Abstract
Cardiac pacing is an effective therapy for treating patients with bradycardia due to sinus node dysfunction or atrioventricular block. However, traditional right ventricular apical pacing (RVAP) causes electric and mechanical dyssynchrony, which is associated with increased risk for atrial arrhythmias and heart failure. Therefore, there is a need to develop a physiological pacing approach that activates the normal cardiac conduction and provides synchronized contraction of ventricles. Although His bundle pacing (HBP) has been widely used as a physiological pacing modality, it is limited by challenging implantation technique, unsatisfactory success rate in patients with wide QRS wave, high pacing capture threshold, and early battery depletion. Recently, the left bundle branch pacing (LBBP), defined as the capture of left bundle branch (LBB) via transventricular septal approach, has emerged as a newly physiological pacing modality. Results from early clinical studies have demonstrated LBBP's feasibility and safety, with rare complications and high success rate. Overall, this approach has been found to provide physiological pacing that guarantees electrical synchrony of the left ventricle with low pacing threshold. This was previously specifically characterized by narrow paced QRS duration, large R waves, fast synchronized left ventricular activation, and correction of left bundle branch block. Therefore, LBBP may be a potential alternative pacing modality for both RVAP and cardiac resynchronization therapy with HBP or biventricular pacing (BVP). However, the technique's widespread adaptation needs further validation to ascertain its safety and efficacy in randomized clinical trials. In this review, we discuss the current knowledge of LBBP.
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Affiliation(s)
- Peng Liu
- Department of Cardiology, The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiaozhu Wang
- Department of Cardiology, The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hongke Sun
- Department of Cardiology, The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinghua Qin
- School of Life Sciences, Northwestern Polytechnical University, Xi'an, China
| | - Qiangsun Zheng
- Department of Cardiology, The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
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132
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Reis GG, Ferrari ADL, Cabral GC, Gazzoni GF, Ley LM, Willes JCF, Ferreira FVC, Lodi LO. Advances in Physiological Cardiac Stimulation. JOURNAL OF CARDIAC ARRHYTHMIAS 2021. [DOI: 10.24207/jca.v34i1.3435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Advances in cardiac stimulation demonstrate that bradyarrhythmia treatments go beyond heart rate control. The concern with the ventricular stimulation site and, consequently, with the maintenance of intraventricular synchrony has become routine in most services. Techniques of physiological cardiac stimulation, such as stimulation of the bundle of His and the left branch, have been improved. Despite the indisputable benefits of these therapeutic modalities, there are technical difficulties that limit systematic use. In this sense, to make physiological cardiac stimulation more practical and reproducible, the concept of parahissian stimulation was expanded and studied. The technique, simpler and reproducible, contemplates a conventional approach of the right ventricle. The big difference is the use of QRS spatial variance analysis technology (Synchromax®, Exo S.A., Argentina) to confirm the maintenance of ventricular synchrony according to the implanted site.
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Affiliation(s)
- Gustavo Galli Reis
- Pontifícia Universidade Católica do Rio Grande do Sul – Hospital São Lucas – Porto Alegre (RS), Brazil
| | - Andres Di Leoni Ferrari
- Pontifícia Universidade Católica do Rio Grande do Sul – Hospital São Lucas – Porto Alegre (RS), Brazil
| | - Gustavo Chiari Cabral
- Pontifícia Universidade Católica do Rio Grande do Sul – Hospital São Lucas – Porto Alegre (RS), Brazil
| | | | - Luis Manuel Ley
- Pontifícia Universidade Católica do Rio Grande do Sul – Hospital São Lucas – Porto Alegre (RS), Brazil
| | | | | | - Laura Orlandini Lodi
- Pontifícia Universidade Católica do Rio Grande do Sul – Hospital São Lucas – Porto Alegre (RS), Brazil
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Alonso P, Plaza D, Cardells I, Oltra P, Mainar L. Evolución de parámetros eléctricos y hemodinámicos tras estimulación ventricular permanente en el área de la rama izquierda. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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134
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Alonso P, Plaza D, Cardells I, Oltra P, Mainar L. Evolution of electrical and hemodynamic parameters after permanent left bundle branch pacing. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:278-279. [PMID: 33115629 DOI: 10.1016/j.rec.2020.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Pau Alonso
- Unidad de Arritmias, Servicio de Cardiología, Hospital de Manises, Manises, Valencia, Spain.
| | - Diego Plaza
- Unidad de Arritmias, Servicio de Cardiología, Hospital de Manises, Manises, Valencia, Spain
| | - Ingrid Cardells
- Servicio de Cardiología, Hospital de Manises, Manises, Valencia, Spain
| | - Paloma Oltra
- Unidad de Arritmias, Servicio de Cardiología, Hospital de Manises, Manises, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Luis Mainar
- Servicio de Cardiología, Hospital de Manises, Manises, Valencia, Spain
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135
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Tang O, Zhou H, Yuan C, Cheng Y, Lv J. Effect of implantation site of the His bundle pacing leads on pacing parameters: a single-center experience. BMC Cardiovasc Disord 2021; 21:112. [PMID: 33627074 PMCID: PMC7905646 DOI: 10.1186/s12872-020-01842-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background HB pacing is a promising approach to achieve physiological pacing, but its efficacy and long-term effects require further validation. In current study, we deemed to investigate the effect of the His bundle pacing (HBP) lead location on pacing parameters. Methods 2D echocardiography imaging was performed after successful implantation, according to which the patients were divided into groups A (whose His lead tips were at the atrial side) and B (whose His lead tips were at the ventricular side). The capture thresholds, sensing values, and H-V intervals between the two groups were compared. Results Thirteen patients were in group A and 16 patients were in group B. The average capture thresholds during, 1 month, and 1 year after operation were 1.20 ± 0.34, 0.69 ± 0.29, and 0.92 ± 0.80 V/0.5 ms for group A and 1.14 ± 0.43, 0.81 ± 0.39, and 0.98 ± 0.59 V/0.5 ms for group B, respectively. The difference between the two groups was not significant. The threshold values in both groups decreased significantly in 1 month and slightly increased in 1 year. The sensing values of group A were 1.87 ± 0.82, 1.95 ± 0.76, and 1.88 ± 0.75 mV, while those of group B were 4.53 ± 1.37, 4.69 ± 1.38, and 4.59 ± 1.42 mV. The difference among the three time points was not significant. However, the sensing values in group A were consistently significantly lower than those in group B. The HV interval in group A was significantly longer than that in group B. Conclusions The implantation site of HBP leads has a significant effect on sensing values for that His leads crossing the tricuspid annulus toward the ventricle are associated with higher sensing values, compared to a more proximal location. Meanwhile, lead location has no evident effect on capture thresholds that is improved significantly shortly after operation.
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Affiliation(s)
- Oushan Tang
- Department of Cardiology, The Second Hospital Affiliated to ShaoXing University, 123 Yan'an Road, Shaoxing, 312000, Zhejiang Province, China.
| | - Haoliang Zhou
- Department of Cardiology, The Second Hospital Affiliated to ShaoXing University, 123 Yan'an Road, Shaoxing, 312000, Zhejiang Province, China
| | - Caidi Yuan
- Department of Ultrasound, The Second Hospital Affiliated to ShaoXing University, 123 Yan'an Road, Shaoxing, 312000, Zhejiang Province, China
| | - Yinhong Cheng
- Department of Cardiology, The Second Hospital Affiliated to ShaoXing University, 123 Yan'an Road, Shaoxing, 312000, Zhejiang Province, China
| | - Jin Lv
- Department of Cardiology, The Second Hospital Affiliated to ShaoXing University, 123 Yan'an Road, Shaoxing, 312000, Zhejiang Province, China
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136
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Jayachandran JV. "Fearfully and wonderfully made"…the Bundle of His. Heart Rhythm 2021; 18:750-751. [PMID: 33556585 DOI: 10.1016/j.hrthm.2021.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 11/24/2022]
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137
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Ellenbogen KA, Padala SK. A deeper look into conduction system pacing: From the bench to the bedside. Heart Rhythm 2021; 18:822-823. [PMID: 33482389 DOI: 10.1016/j.hrthm.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Kenneth A Ellenbogen
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
| | - Santosh K Padala
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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138
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Teigeler T, Kolominsky J, Vo C, Shepard RK, Kalahasty G, Kron J, Huizar JF, Kaszala K, Tan AY, Koneru JN, Ellenbogen KA, Padala SK. Intermediate-term performance and safety of His-bundle pacing leads: A single-center experience. Heart Rhythm 2021; 18:743-749. [PMID: 33418127 DOI: 10.1016/j.hrthm.2020.12.031] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 12/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The short-term safety, feasibility, and performance of His-bundle pacing (HBP) leads have been reported; however, their longer-term performance beyond 1 year remains unclear. OBJECTIVE The purpose of this study was to examine the intermediate-term performance and safety of HBP. METHODS All HBP lead implants at Virginia Commonwealth University between January 2014 and January 2019 were analyzed. HBP was performed using a Medtronic SelectSecure 3830-69 cm pacing lead. RESULTS Of 295 attempts, successful HBP implantation (selective or nonselective) was seen in 274 cases (93%). Mean follow-up duration was 22.8 ± 19.5 months (median 19.5; interquartile range 11-33). Mean age was 69 ± 15 years; 58% were males; and ejection fraction <50% was noted in 30%. Indications for pacemaker included sick sinus syndrome in 41%, atrioventricular block in 36%, cardiac resynchronization therapy in 7%, and refractory atrial fibrillation in 15%. Selective HBP was achieved in 33%. Mean HBP capture threshold at implant was 1.1 ± 0.9 V at 0.8 ± 0.2 ms, which significantly increased at chronic follow-up to 1.7 ± 1.1 V at 0.8 ± 0.3 ms (P <.001). Threshold was ≥2.5 V in 24% of patients, and 28% had an increase in HBP threshold ≥1 V. Loss of His-bundle capture at follow-up (septal right ventricular pacing) was seen in 17%. There was a total of 31 (11%) lead revisions, primarily for unacceptably high thresholds. CONCLUSION Although HBP can prevent or improve pacing-induced cardiomyopathy, the elevated capture thresholds, loss of His-bundle capture, and lead revision rates at intermediate follow-up are of concern. Longer-term follow-up data from multiple centers are needed.
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Affiliation(s)
- Todd Teigeler
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jeffrey Kolominsky
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Chau Vo
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Richard K Shepard
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Gautham Kalahasty
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jordana Kron
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jose F Huizar
- Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Karoly Kaszala
- Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Alex Y Tan
- Division of Cardiac Electrophysiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Jayanthi N Koneru
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia
| | - Santosh K Padala
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia.
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139
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De Pooter J, Calle S, Timmermans F, Van Heuverswyn F. Left bundle branch area pacing using stylet‐driven pacing leads with a new delivery sheath: A comparison with lumen‐less leads. J Cardiovasc Electrophysiol 2021; 32:439-448. [DOI: 10.1111/jce.14851] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/26/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jan De Pooter
- Heart Center Ghent University Hospital Ghent Belgium
| | - Simon Calle
- Heart Center Ghent University Hospital Ghent Belgium
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140
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Chen AY, Upadhyay GA. Current Treatment Options in Cardiovascular Medicine Arrhythmia Section From the His Bundle to the Left Bundle: Clinical Applications of Conduction System Pacing. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00880-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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141
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Chaumont C, Auquier N, Milhem A, Mirolo A, Al Arnaout A, Popescu E, Viart G, Godin B, Gillibert A, Savouré A, Eltchaninoff H, Anselme F. Can permanent His bundle pacing be safely started by operators new to this technique? Data from a multicenter registry. J Cardiovasc Electrophysiol 2020; 32:417-427. [PMID: 33373093 DOI: 10.1111/jce.14860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the risk of heart failure and atrial fibrillation in long term. His bundle pacing (HBP) is a physiological alternative to RVP, and could overcome its drawbacks. Recent studies assessed the feasibility and safety of HBP in expert centers with a vast experience of this technique. These results may not apply to less experienced centers. We aim to evaluate the feasibility and safety of permanent HBP performed by physicians who are new to this technique. METHODS We included all patients who underwent pacemaker implantation with attempt of HBP in three hospitals between September 2017 and January 2020. Indication for HBP was left to operators' discretion. All the operators were new for HBP. His bundle (HB) electrical parameters were recorded at implant, 3- and 12-month follow-up. RESULTS HBP was successful in 141 of 170 patients (82.9%); selective HBP was obtained in 96 patients and nonselective HBP in 45. The mean procedure and fluoroscopy durations were 67.0 ± 28.8 min, and 7.3 ± 8.1 min (3.1 ± 4.1 Gy·cm2 ), respectively. The mean HB paced QRS duration was 106 ± 18 ms. The mean HB capture threshold was 1.29 ± 0.77 V and did not increase at 3- and 12-month follow-up. The ventricular lead revision was required in five patients. Our results showed a rapid technical learning allowing a high procedure success rate (89.8%) after 15 procedures. CONCLUSION HBP performed by operators new to this technique appeared feasible and safe. This should encourage HBP to be performed in patients expected to experience high RVP burden.
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Affiliation(s)
- Corentin Chaumont
- Department of Cardiology, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, Rouen, France
| | - Nathanael Auquier
- Department of Cardiology, Groupe Hospitalier du Havre, Le Havre, France
| | - Antoine Milhem
- Department of Cardiology, La Rochelle Hospital, La Rochelle, France
| | - Adrian Mirolo
- Department of Cardiology, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, Rouen, France
| | - Alain Al Arnaout
- Department of Cardiology, La Rochelle Hospital, La Rochelle, France
| | - Elena Popescu
- Department of Cardiology, Groupe Hospitalier du Havre, Le Havre, France
| | - Guillaume Viart
- Department of Cardiology, Rouen University Hospital, Rouen, France
| | - Bénédicte Godin
- Department of Cardiology, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, Rouen, France
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Arnaud Savouré
- Department of Cardiology, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, Rouen, France
| | - Hélène Eltchaninoff
- Department of Cardiology, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, Rouen, France
| | - Frédéric Anselme
- Department of Cardiology, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, Rouen, France
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142
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Prinzen FW, Vernooy K. Do we need to pace the bundle? Editorial comment on: Nonselective versus selective His bundle pacing: An acute intrapatient speckle tracking strain echocardiographic study by Bednarek et al. J Cardiovasc Electrophysiol 2020; 32:126-128. [PMID: 33290636 DOI: 10.1111/jce.14832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
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143
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Wu H, Chen J, Lin K, Chang K. Automatic capture management may cause unnecessary battery depletion in selective his-bundle pacing. Clin Case Rep 2020; 8:2443-2446. [PMID: 33363756 PMCID: PMC7752502 DOI: 10.1002/ccr3.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/28/2020] [Accepted: 07/01/2020] [Indexed: 12/04/2022] Open
Abstract
A routine change in the automatic capture management algorithm from "adaptive" to "off or monitor" is required to conserve device longevity in a permanent pacemaker with His-bundle pacing.
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Affiliation(s)
- Hung‐Pin Wu
- Division of Cardiovascular MedicineDepartment of MedicineChina Medical University HospitalTaichungTaiwan
- School of MedicineChina Medical UniversityTaichungTaiwan
| | - Jan‐Yow Chen
- Division of Cardiovascular MedicineDepartment of MedicineChina Medical University HospitalTaichungTaiwan
- School of MedicineChina Medical UniversityTaichungTaiwan
| | - Kuo‐Hung Lin
- Division of Cardiovascular MedicineDepartment of MedicineChina Medical University HospitalTaichungTaiwan
- School of MedicineChina Medical UniversityTaichungTaiwan
| | - Kuan‐Cheng Chang
- Division of Cardiovascular MedicineDepartment of MedicineChina Medical University HospitalTaichungTaiwan
- School of MedicineChina Medical UniversityTaichungTaiwan
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144
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Left bundle branch area pacing after His bundle pacing for cardiac resynchronization in a patient with dextrocardia. HeartRhythm Case Rep 2020; 6:907-909. [PMID: 33365236 PMCID: PMC7749210 DOI: 10.1016/j.hrcr.2020.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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145
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Arnold AD, Whinnett ZI, Vijayaraman P. His-Purkinje Conduction System Pacing: State of the Art in 2020. Arrhythm Electrophysiol Rev 2020; 9:136-145. [PMID: 33240509 PMCID: PMC7675135 DOI: 10.15420/aer.2020.14] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/30/2020] [Indexed: 01/02/2023] Open
Abstract
Conduction system pacing involves directly stimulating the specialised His-Purkinje cardiac conduction system with the aim of activating the ventricles physiologically, in contrast to the dyssynchronous activation produced by conventional myocardial pacing. Since the first report of permanent His bundle pacing (HBP) in 2000, the stylet-driven technique of its earliest incarnation has been superseded by a more successful stylet-less approach. Widespread uptake has led to a much greater evidence base. Single-centre observational studies have now been supported by large multicentre, international registries, mechanistic studies and the first randomised controlled trials. New evidence has elucidated mechanisms of HBP and illustrated the nature and magnitude of its potential benefits for preventing pacing-induced cardiomyopathy and correcting bundle branch block. Left bundle branch pacing (LBBP) is a newer technique in which the lead is fixed deep into the left side of the intraventricular septum to allow capture of the left bundle, distal to the His bundle. LBBP holds promise as a method for physiological pacing that overcomes some of the fixation, threshold and sensing challenges of HBP. In this state-of-the-art review of His-Purkinje conduction system pacing, the authors assess recent evidence and current practice and explore emerging and future directions in this rapidly evolving field.
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Affiliation(s)
- Ahran D Arnold
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, US
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146
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Rossi JM, de Almeida DR, Atik FA, Avila MS, Bonatto MG. Emerging Topics in Heart Failure: Interventional Heart Failure Therapies. Arq Bras Cardiol 2020; 115:953-955. [PMID: 33295464 PMCID: PMC8452214 DOI: 10.36660/abc.20201086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- João Manoel Rossi
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | | | - Fernando Antibas Atik
- Universidade de BrasíliaBrasíliaDFBrasilUniversidade de Brasília, Brasília, DF - Brasil
| | - Monica Samuel Avila
- Universidade de São PauloInstituto do Coração do Hospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Marcely Gimenes Bonatto
- Hospital Santa Casa de Misericórdia de CuritibaCuritibaPRBrasilHospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR - Brasil
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147
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Heckman L, Vijayaraman P, Luermans J, Stipdonk AMW, Salden F, Maass AH, Prinzen FW, Vernooy K. Novel bradycardia pacing strategies. Heart 2020; 106:1883-1889. [DOI: 10.1136/heartjnl-2020-316849] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/08/2020] [Accepted: 08/30/2020] [Indexed: 11/04/2022] Open
Abstract
The adverse effects of ventricular dyssynchrony induced by right ventricular (RV) pacing has led to alternative pacing strategies, such as biventricular, His bundle (HBP), LV septal (LVSP) and left bundle branch pacing (LBBP). Given the overlap, LVSP and LBBP are also collectively referred to as left bundle branch area pacing (LBBAP). Although among these alternative pacing sites HBP is theoretically the ideal strategy as it maintains a physiological ventricular activation, its application requires more skills and is associated with the most complications. LBBAP, where the ventricular pacing lead is advanced through the interventricular septum to its left side, creates ventricular activation that is only slightly more dyssynchronous. Preliminary studies have shown that LBBAP is feasible, safe and encounters less limitations than HBP. Further studies are needed to differentiate between LVSP and LBBP with regard to acute functional and long-term clinical outcome.
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148
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Hua W, Fan X, Li X, Niu H, Gu M, Ning X, Hu Y, Gold MR, Zhang S. Comparison of Left Bundle Branch and His Bundle Pacing in Bradycardia Patients. JACC Clin Electrophysiol 2020; 6:1291-1299. [DOI: 10.1016/j.jacep.2020.05.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
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149
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Jiang H, Hou X, Qian Z, Wang Y, Tang L, Qiu Y, Jiang Z, Chen X, Li K, Zou J. A novel 9-partition method using fluoroscopic images for guiding left bundle branch pacing. Heart Rhythm 2020; 17:1759-1767. [DOI: 10.1016/j.hrthm.2020.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
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150
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Vijayaraman P, Dandamudi G, Subzposh FA, Shepard RK, Kalahasty G, Padala SK, Strobel JS, Bauch TD, Ellenbogen KA, Bergemann T, Hughes L, Harris ML, Fagan DH, Yang Z, Koneru JN. Imaging-Based Localization of His Bundle Pacing Electrodes: Results From the Prospective IMAGE-HBP Study. JACC Clin Electrophysiol 2020; 7:73-84. [PMID: 33478715 DOI: 10.1016/j.jacep.2020.07.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to evaluate the correlation between His bundle (HB) pacing (HBP) implantation characteristics, lead-tip location, and association of intraprocedural His recordings with approximated HB anatomic landmarks using computed tomography (CT) imaging. BACKGROUND HBP continues to grow in clinical practice due to offering true physiological pacing. However, a clear understanding of HB anatomy and the lead-tip location's influence on pacing characteristics is lacking. METHODS The IMAGE-HBP study (Imaging Study of Lead Implant for His Bundle Pacing) was a prospective, multicenter study designed to assess implantation characteristics of the SelectSecure Model 3830 lead placed at the HB, evaluate protocol-specified HBP success (His recording present on electrogram and HBP threshold ≤2.5 V at 1 ms), and correlation between lead-tip location by CT imaging and HBP characteristics as well as lead-related complications through 12 months. RESULTS Sixty-nine patients underwent a lead implantation attempt at the HB. Of these, 61 patients (88%) had a lead successfully implanted at the HB, and 52 patients (75%) met the pre-specified definition of successful HBP. In 51 patients with CT imaging, 11 leads (22%) were placed in the atrial aspect of the HB region (36% selective HBP), and 40 leads (78%) were placed in the ventricular aspect (28% selective HBP). Four of the 51 patients had P-wave oversensing, all with leads in the atrium. Freedom from lead-related complication at 12 months was 93%. CONCLUSIONS Successful HBP could be achieved at lead-tip locations in the atrium or ventricle but is preferable in the ventricle to eliminate risk of oversensing. The IMAGE-HBP study offers better insight into approximated HB anatomic landmarks, lead-tip location, and correlation with pacing characteristics. (Imaging Study of Lead Implant for His Bundle Pacing [IMAGE-HBP]; NCT03294317).
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Affiliation(s)
| | - Gopi Dandamudi
- Division of Cardiology, Division of Cardiac Electrophysiology, Indiana University, Indianapolis, Indiana, USA
| | | | - Richard K Shepard
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gautham Kalahasty
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | - Santosh K Padala
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | - John S Strobel
- Division of Cardiology, Division of Cardiac Electrophysiology, Indiana University, Indianapolis, Indiana, USA
| | - Terry D Bauch
- Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA
| | - Kenneth A Ellenbogen
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Lisa Hughes
- Medtronic, Inc., Mounds View, Minnesota, USA
| | | | | | | | - Jayanthi N Koneru
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
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